Ethical Considerations

Ethical considerations were very important in the planning, design, implantation and analysis of this research project. My research does not identify any individuals and participants in the study have been guaranteed the absolute in the research project. I have considered all the ethical issues generated by research study and have complied with the University of Warwick’s Research Code of Conduct and Guidelines on ethical practices. Research permission/ authorization from the Tigray State Regional Government Bureau of Health and research ethics clearance from the Mekelle University College of Health Research Ethics Committee were also secured before the commencement of data collection. I also briefed the management teams in both the Mekelle hospital and Korem health centre on the purpose of the research and methods of data collection.

Moreover, all respondents were requested to consent their participation in the study in writing or verbally for those who cannot read and write. The information sheet was read out to all participants and verbal explanation of the research was given in each session before consent to participate in the study is requested. (See Annex A and B) Following the discussion, the information sheets were provided to respondents to keep it as a record or for my contact details. The study was described as being about HIV

151 testing women during pregnancy. Respondents marked on the consent forms or gave verbal consent to participate in the study.

In addition, respondents were guaranteed the anonymity of any data generated from their involvement in the project to maintain the confidentiality of the information collected. Where respondents are cited some general demographic data is given to outline the context in which women understand and attempt to exercise their rights, but not sufficient to be able to identify the respondent. This was particularly important to avoid any possible repercussion that could be inflicted on respondents in relation to their right to access to the health services be it in relation to HIV treatment or other services. However, I was surprise to find out that every time I communicated to my respondents that data given by them will remain anonymous, many objected expressly claiming that they have no fear of any kind even if their identity is disclosed since they will only tell the truth. A 27 old respondent from Mekelle said ‘... I am going to talk about myself, my experience and I will only tell you the truth so ... there is nothing that I

fear about even if you used my real name ...’ (interview # 3). However, even in cases of such clear

statement of the participants I remained faithful to the ethical standard and collected the data anonymously by removing names of people and places.

However, obtaining traditional signed consent forms was less appropriate in my fieldwork with women in the rural settings, where many of my respondents were suspicious of the consent form and declined to sign the forms for undisclosed reason but with the disguise of not being able to read and write. Hence I only got their oral consent to participate in the research. 19 women mainly respondents from Mekelle signed the consent form after my explanation that the form is just in order to meet the ethical standard. Despite these difficulties with the consent form, I nonetheless experienced the issue of informed consent

152 to participate in research as an important tool with which to establish some of the basic principles of my research – such as confidentiality, anonymity, voluntary participation and the opportunity to withdraw – and to encourage participants to view the interview as a ‘guided conversation’ by asking me questions back during the interview.

Respondents were also given the opportunity to withdraw consent from the interview or the use of data generated at any point. However no respondents have withdrawn from the interview even though many of the respondents were indicating to me that they are in hurry want to finish the interview as quick as possible. This was understandable taking under consideration of the busy life of women in Tigray who shoulder all the burden of household chores.

4.7 Conclusion

Seeking to achieve the objectives of this study an approach was needed that would facilitate the generation of data that represents the values, feelings, personal experiences and attitudes of the women who took HIV testing during their pregnancies or child birth. Discussions of HIV testing approaches are complex subject that involves understandings of global policies, national legal frameworks, gender power relations and deep-rooted socio cultural norms. A qualitative approach was deemed well suited to such aim as it allows a more robust generation, description, interpretation and analysis of data that provide insight into the subjective experiences of women in relation to exercising their autonomous decision making regarding the HIV test offered during their pregnancies. Hence, in-depth semi- structured interview was employed in this thesis as the main data collection tool though this study is also

153 informed by data collected through non participatory observation and field notes gathered during the fieldwork period. In addition, the normative and conceptual aspects of human rights and ethical principles inform the thrust of discussions and arguments in this thesis. Hence the study was shaped and refined with the data gathered from interview with women and other interviewees, observational data, field notes and themes identified from document reviews.

The study was conducted in both urban and rural settings. Participants were recruited from members of mother–to-mother support group that function in health facilities as forum where HIV positive mother help each other. Interviews were conducted at the health facilities upon the recruitment of the research subjects based on the selection criteria. Before each interview, informed consent was sought from each participant. Following the interviewee with women who tested HIV positive during their pregnancies, key informant interviews were held with health care providers, heath workers and mentor mothers of the M2M support groups. The following chapters of the thesis present the findings that framed the stud

CHAPTER –FIVE

FINDINGS I: HIV TESTING OF PREGNANT WOMEN AND THE COUNSELLING